In 2016, NYPD officers responded to more than 400 calls a day concerning “emotionally disturbed persons,” some of whom are suffering major psychiatric episodes. Officers receiving CIT training are better prepared to de-escalate these encounters.

CIT training has become a priority for big-city police departments, but as Eide notes, even the best-trained force can’t compensate for declining mental health services.

Stephen Eide is a senior fellow at the Manhattan Institute and an expert on public administration and urban policy. His story “CIT and Its Limits” (coauthored with Carolyn Gorman) appears in the Summer 2017 issue of CityJournal.

Audio Transcript

Seth Barron: Last year, police officers in New York City responded to nearly 150,000 calls for emotionally disturbed persons, or EDPs. That’s a rate of more than 400 per day. Unfortunately, interactions between officers and people with serious mental illnesses can escalate quickly and often have tragic consequences. Police departments increasingly are training officers in crisis intervention to deescalate such situations. These programs, modeled on techniques used in hostage negotiation training, teach officers about mental illness and its varieties, symptoms, and prospects for treatment. Cops participate in role-playing scenarios with actors playing people suffering major psychiatric episodes. Crisis Intervention Training has become a priority for big-city police departments across the country. In the Summer issue of City Journal, Stephen Eide and his coauthor Carolyn Gorman, studied the NYPD’s Crisis Intervention Team training and reported back to us in a piece entitled “CIT and Its Limits.” We will talk to Stephen after this.

Brian Anderson: Hello, I am City Journal editor Brian Anderson. Thanks for joining us for the 10 Blocks Podcast, featuring urban policy and cultural commentary with City Journal editors, contributors, and special guests.

Seth Barron: What is Crisis Intervention Training? And what are its origins?

Stephen Eide: It is a technique that police departments use to train officers in how to deescalate calls when police officers are brought to the scene of a person in an emotionally disturbed – an emotionally disturbed person, or a person in a state of psychiatric crisis. You know, the teach them to – by deescalate, I mean take things that are certainly sort of like what you would use to address hostage situations. So, you know, you ask the person, you try to develop a rapport with the person, you ask them open-ended questions. You don’t kind of buy into their mental illness, you don’t try to exaggerate it, but you also try to develop some sort of bond with them in hopes that you kind of get them talking and get them to just basically calm down so that they can then listen to reason and, you know, you figure out what type of services they need and if this is something that you know, do they need to go to a hospital? Maybe nothing needs to be done. That is ultimately what you are trying to get to with Crisis Intervention Training.

Seth Barron: We mentioned in the introduction that New York City police respond to more than 400 emotionally disturbed person calls every day. Maybe you can illustrate for our listeners an example of the typical EDP call and some of the complications involved for the officers, where, you know, no crime has necessarily been committed.

Stephen Eide: Right. So, you know, the nature of policework, and especially we are talking about, you know, being a patrol officer on the beat, is that you get called to address a variety of situations. It’s not necessarily the case that some crime is in the process of being committed, but there is some sort of a disorder, or, basically, you know, somebody wants service for various reasons, so they call 911, these problems always fall in police officers’ lap. So, in the case of an EDP call, first of all, the number of EDP calls, that’s a number that – that’s a designation that the dispatcher gives to a call that is placed. There are also calls involving people in psychiatric distress that are not necessarily classified as EDP calls, so, in fact, the number is larger than the number that you cited in terms of daily dealings with people in the state of some sort of psychiatric crisis in terms of the NYPD. But yeah, maybe, you know, you have someone who is living with a relative, they have had some issues with their medications over the years, maybe they have had, you know, a rocky employment history, in and out of psychiatric hospitals, they were stable for a period, they have been unstable at other periods, and maybe they are transitioning to an unstable period and so they call to – they place a call, a 911 call, and the officer comes and the officer has to figure out whether or not this is something that is about to escalate that can be violent, potentially, or if it’s something that, you know, just within a, you know, handled correctly, no further work will need to be done and we can just – everyone can go on with their daily lives.

Seth Barron: I see. The conversation about mental crisis training in the NYPD really took off last year after the death of a 66-year-old schizophrenic woman named Deborah Danner in the Bronx. Can you talk about what happened?

Stephen Eide: Well, this was a woman who had been – a long history of serious mental illness. She had, at times, been stable in her life. She is connected to a provider of mental health services that has a good reputation and is Fountain House, there was at one point a change in her medication regimen, she stopped doing as well, she became distanced from Fountain House, and then yeah, she was on her own living in the Bronx and I think, if I recall correctly, the police responded to a call and she ran out naked, attacking them, brandishing a knife and they shot them.* I mean, this was a small woman, it was a tense situation, so there was a lot of you know, concern about whether or not it was handled correctly, and one of the officers, I believe, has been indicted for second-degree murder. We don’t know what the outcome of that will be, but you know, unfortunately this will happen sometimes. I should mention that the overwhelming majority of those hundreds of daily calls involving emotionally disturbed people don’t wind up like this, but a handful do and these are the ones that attract attention and also force a policy discussion.

Seth Barron: It seems like a misallocation of resources to have law enforcement responding to calls that really sound like you know, they are medically related. I mean, if a schizophrenic person is, you know, having some kind of an episode, why are the police the first responders in such a case?

Stephen Eide: Yeah, well if you go back to kind of the intellectual history of something like broken windows policing that developed out of people like James Q. Wilson going around and looking at what patrol officers do, and mostly what patrol officers do is they maintain order in the streets. Small business owner, local citizen, they want – the problem that they want help with, and so these problems fall in the police officers’ lap, inevitably, on a daily basis order maintenance is most of what patrol officers do. Well, one leading cause of disorder in our streets right now is untreated mental illness. This is – no one, I think, is particularly satisfied with our mental healthcare system at the moment, there is a real question of how much better it is going to get in the near-term, but while we still have this problem of untreated mental illness, we are going to have disorder in the streets related to untreated mental illness. People are going to want someone to do something about it now and inevitably that someone usually is going to be a police officer.

Seth Barron: So, what percentage of violent interactions between police and the public really are, you know, avoidable in the sense that these are, you know, mentally ill people that the police, unfortunately, wind up shooting, you know, injuring? Is this a very common problem?

Stephen Eide: Well, it’s – police shooting of civilians are not a common problem in general. I mean, if you look – this is in police shootings of mentally ill people are a quite – fairly rare occurrence but they happen more frequently than anybody, including the police, would like them to happen. There are no, I think, reliable statistics on how frequently they happen, but certainly, you know, seriously mentally ill people comprise a larger portion of the total number of fatal police shootings than is there you know, share of the total population. I mean, the seriously mentally ill people say like four, five percent of the adult population. More police shootings of civilians who have mental illness is certainly a figure of more than four or five percent.

Seth Barron: Okay. Now, you visited the NYPD facilities where they train officers in crisis intervention. Can you give us any details about the program, you know, its size and its methods? Maybe you could walk us through some of the training scenarios you wrote about in your essay.

Stephen Eide: Well, I think, you know, overall what the NYPD is trying to teach is deescalation. As you mentioned in your intro, it is like what you teach hostage negotiators. And they do this – they have a few different ways of teaching this. First of all, what seemed to me the part that the patrol officers thought most interesting is just explaining about the nature of mental illness, the history of deinstitutionalization, you know, the nature of our mental healthcare system. What is bipolar disorder, what is PTSD? Those are things that I think the policemen thought were especially interesting and then yeah, they observe actors playing people in a state of kind of acute psychosis and they practice resolving these situations while being observed by social workers and also their colleagues. The NYPD’s approach is to train, kind of, as many officers as possible. They are focusing on volume in training thousands of patrol officers. There is another approach that other CIT programs endorse, which is that you essentially train kind of squads of specialists, like SWAT teams of CIT-trained people. That is not what the NYPD is doing, and there are people in the CIT community who have different views on which is the best model, but ultimately the hope is that, you know, at least at all times in each precinct, you have somebody available who is CIT-trained who can be involved in responding to one of these calls when the call comes in.

Seth Barron: Have you spoken to any NYPD officers who have had this kind of training and what do they say about it? Does it work? Is the situation regarding EDPs, you know, emotionally disturbed people, is it worse now than it used to be? Where are we headed with this? Are the outcomes good?

Stephen Eide: Well, the people who take the training say that they like it. I mean it is working in the sense that it is popular, it is very rare to find somebody inside the NYPD or outside who is kind of against CIT. I think it is very difficult to evaluate kind of hard outcomes. You know, again, if what you are ultimately trying to do is reduce the number of police shootings of mentally ill people, first of all we have to talk about the many problems with our mental healthcare system to begin with, and second of all, that number is very small to begin with. So, it’s going to be hard to evaluate the success based upon that. I think it is a good idea, it is something that officers – that can be helpful for officers, and since these situations seem to be increasing in recent years in terms of officer’s contact with EDP calls, then we are going to need this type of training because you know, it’s not realistic to expect that our mental healthcare system is going to be perfectly reformed anytime soon.

Seth Barron: So, it seems like what we would really like to do is reduce the number of EDP calls that come in. You have written previously about the seriously mentally ill and assisted outpatient treatment. Can you talk a little bit about how that might help?

Stephen Eide: Well, assisted outpatient treatment puts the seriously mentally ill people with a history of noncompliance with treatment under a court-mandated treatment program. Like, it is a good program, but like, but it is part – it is one piece of our very fragmented mental healthcare system. I mean, it’s not really a system at all, that’s just a term that we use in more a kind of aspirational sense than anything. Because we don’t want to keep people inside mental institutions like we used to up until the 1950s, which was our only form of mental illness policy, we have a variety of programs, services, various funding streams, that are supposed to help people where they are. So AOT, assisted outpatient treatment, that’s a program that is going to help some people, maybe it could help more people than it is helping right now. But people who are in a state of like, really severe psychosis, who are not going to listen to a judge or a court, it’s not going to help them. That’s somebody who needs to be in a hospital most likely. And there are many other examples like this of things that are going to help certain segments of the population, connecting each member of the population who has a seriously mental illness with the best service or program for them is very challenging and it’s not clear if that’s something that – if that’s a goal that we will ever achieve, that it is possible to have in an effective yet fragmented mental healthcare system, but that’s a system we seem to be committed to.